“We observed rapid healthcare quality improvements in participating facilities, driven by staff enthusiasm and commitment to the program. the safecare program inspires and engages professionals at all levels”
Dr Christine Kerubo, MD - Quality and Patient Safety Consultant, Kampala Pharmaceutical Industries
Improving quality of care
More than 5 million people die in low- and middle-income countries every year because of poor quality of care – even more than the 3.6 million people who die due to a lack of access to care.
SafeCare creates transparency on quality of care, thus contributing to a virtuous cycle of trust throughout the health system. SafeCare comprises internationally (ISQua) accredited standards and a stepwise certification approach to improve the quality of care in healthcare facilities, tailor-made for the realities of resource-limited settings.
Transparency on quality (data) is the starting point of quality improvement and increasing trust in the healthcare system. Stakeholders need quality data to accurately assess medical, financial, and accountability risks before they invest in health system quality. Public and private insurance companies need data to determine which providers will assure quality, value for money, and patient satisfaction.
Data connects SafeCare and patient journeys: SafeCare monitors the quality of the healthcare provider, in 2024, we linked maternity journeys, as a “Maternity Rating,” integrating SafeCare and MomCare data into one unified system.
Much of our work in 2024 was geared towards scaling our impact. Thanks to our approach, digital tools, continuous learning and license model, we can bring benefits to new partners in our core countries and scale rapidly to new countries. We aimed to increase SafeCare’s footprint through public and private partners in Africa and South and Southeast Asia, and build new coalitions to further embed quality in the health system framework in our core countries and beyond. Opening an SafeCare office in India was a transformative step that shows the power of expansion and the importance of local ownership.
Creating impact in Kenya, Tanzania, Nigeria, and Ghana
In 2024, SafeCare further strengthened embedding of quality in the healthcare ecosystems in our core countries through the adoption of SafeCare’s quality standards by public partners and licensing to private partners.
In Nigeria, we collaborated with major ecosystem payers – for example, the National Health Insurance Authority (NHIA) and the Lagos State Health Management Agency (LASHMA). We signed an agreement with NHIA, the largest purchaser of healthcare with a network of over 7,000 public and private health facilities in Nigeria, whereby they will use our approach for quality measurement.
In Ghana, SafeCare made significant strides in developing a scalable SafeCare model, in partnership with Christian Health Association of Ghana (CHAG) and Ghana Health Services (GHS), with over 8,000 facilities. Governance structures were initiated within both organizations to enable ownership and sustainability of quality improvement across their networks. CHAG, with 330 linked healthcare providers, made important steps towards a sustainable quality model in their network. In parallel, a pilot was developed and tested with GHS facilities across three regions, paving the way for broader national adoption.
First SafeCare Assessor Graduation at CHAG
In Kenya, SafeCare supported counties like Kisumu and Homabay using virtual assessments for quality mapping and provided the government with technical assistance for the Ministry of Health’s quality framework and quality of care bill. And in Tanzania, SafeCare supported further steps towards sustainability and ownership of the Ministry of Health Zanzibar’s SafeCare-based standards.
Across these core countries, we focused our capacity building on quality processes that have the biggest direct impact on patient safety. Infection prevention control is one of those essential elements, as mortality after infection is 22%. In 2024, the availability of fully functional handwashing facilities, for example, improved from 51% to 71%.
The level of quality in our longstanding networks is improving, for example, with five Christian Social Services Committee facilities in Tanzania receiving the highest level of quality. However, facilities still lack critical procedures that impact patients' health. More than 40 percent of the facilities in our network are at the lowest quality level, risk management is still actually implemented in less than 40% of the facilities, and quality improvement for our whole network remained stable at 74% in 2024.
In Kenya, quality improvement even decreased, with only 59% of facilities showing quality improvement, in part due to the transition from National Health Insurance Fund to the new Social Health Insurance Fund.
CSSC Facility celebrating level 5
Nigeria however stood out, with 86% of the public facilities improving compared to the previous assessment. This is quite an achievement in public facilities, and it’s thanks to the training of dedicated teams on our platform and proactive usage of the data revealing quality gaps.
Incentivizing and institutionalizing a culture of quality
A culture of quality means that quality is top of mind and integrated into the daily practice of healthcare providers, and that staff members are motivated to take part in a journey to better care.
We work with partners to incentivize quality. For example, the Lagos State Health Management Agency (LASHMA) in Nigeria pioneered a quality-based performance tariff system in 2024, incentivizing quality by paying higher reimbursements to health facilities that achieve higher SafeCare levels (level 4/5).
The Quality platform enables healthcare facilities to work on quality improvement digitally, with real-time progress information, benchmarking data to stimulate positive competition, and chat and push messages to enhance contact moments.
In 2024, there was a steep rise in usage of the platform, from 1,600 healthcare staff at 490 facilities in 2023 to 6,000 healthcare staff at 1,400 facilities in 2024. Users downloaded more than 60,000 documents from the SafeCare library in 2024, compared to 14,000 in 2023.
Growing our presence in Africa and South and Southeast Asia
Digital tools and continuous innovation, including the Quality Platform, enables SafeCare to optimize and increase users’ focus on quality through low-cost, remote, and digital support, helping our partners to become more effective and efficient.
By the end of 2024, we had 36 partners in 25 countries using the SafeCare methodology within the public and private sector. By applying the experience and best practices from our core countries, we can rapidly scale beyond them.
We continued our technical assistance for the USAID Ireme program in Rwanda, supporting the development of mental health standards and digitization of the Hospital Accreditation Standards. We also signed a license agreement with Kampala Pharmaceutical Industries to further scale SafeCare in Kenya, Tanzania, Uganda, Pakistan, Tajikistan, and Syria.
In Somalia, 15 facilities received a SafeCare entry level assessment via our license partner Catex Health. The Federal Ministry of Health Somalia requested SafeCare’s support for implementation of a national quality management framework that we will further design in 2025.
In India, we established a new SafeCare entity to support our partners in South and Southeast Asia, to enable our work for Manyata for Mothers and expand our reach in India and new countries, such as Nepal and Cambodia.
In Ethiopia, we engaged with public and private stakeholders. The Ethiopian Ministry of Health will launch the Hospital Accreditation Standards in 2025. SafeCare received endorsement from the Ministry of Health for SafeCare implementation in the private sector to prepare facilities for accreditation. Other new engagement countries include Cote D’Ivoire.
The impact of SafeCare in Ghana
A study exploring the views and experiences of frontline health staff and policy makers on the SafeCare quality improvement programme in Ghana revealed that the SafeCare QI programme has contributed to QI and adherence to patient safety standards in Ghana. However, it also highlighted the importance of continuous government commitment for sustainability. Read the full study: BioMed Central (BMC)
Med4All
In Sub-Saharan Africa, the circulation of poor quality or fake drugs is a serious challenge. PharmAccess is applying digitally enabled group purchasing to tackle the problem: in Ghana, the digital platform Med4All aims to make quality medicines widely accessible at affordable prices.
The operational model for Med4All underwent a comprehensive review in 2024 in partnership with Health4Development, leading to a refined business case focused on long-term sustainability, growth, and improved governance. Med4All and the Medical Credit Fund (MCF) co-developed a new loan product tailored to support CHAG facilities in procuring high-quality medicines through the Med4All platform.
Transparent supply chains are one of the healthcare system’s big challenges, with perverse incentives hampering transformation. They are the main reason why comparable initiatives in Africa are struggling to scale or have even closed. We are therefore in partnership with Health4Development connecting with organizations in other countries that are working towards the same goal, such as DrugStoc and iPlussolutions. Together, we are finding ways to collaborate, e.g. on developing the tech platform and financing solutions.
A medicine quality study for Med4All in 24 CHAG providers in Ghana indicated 1 in 8 were substandard. With more sensitive methods, 1 in 4 failed to pass the pharmacopoeia standard. No differences were found between facilities that started Med4All versus those that did not. This is a strong baseline for follow-up in 2026 for final evaluation. Read the full study: PubMed Central (PMC)